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Early Identification in Mental Illness

Tara Niendam, Ph.D.

Associate ProfessorUC Davis Health System

Executive DirectorUC Davis SacEDAPT Clinic

http://earlypsychosis.uc.davis.edu

Objectivesl Develop shared understanding of mental

health causes and reasons for identifying students who are struggling

l Recognize possible signs of mental health challenges in students

l How to respond and refer students for assessment and intervention

Topics to be coveredl What is “mental illness”?l Stress & Coping

l 3 Mental Health conditions:l Anxiety l Depressionl Psychosis

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Stigma & Mental Illness“Snap out of it! Don’t be such a wuss.”

“Nothing is wrong with you – you’re just being a teenager!”

“Stop being so emotional!”

What sort of things have you heard people say to someone who is struggling with emotional or

psychological problems???

Stigma & Mental Illnessl For individuals struggling with mental illness,

our society is often cruel and judgmental.l We tend to see mental illness as a sign of

weakness that is shameful.

l Fear of judgment and lack of knowledge about available services often prevent people from speaking up and seeking help.l Avoidance of problems is not the best solution!

Stigma & Mental Illnessl Information is the key!

l We tend to be negative about things when we don’t understand them

l Increasing awareness improves health for everyonel Example: Breast cancer awareness month in October l MAY is Mental Health awareness month

l Today we are going to talk about the early signs of 3 common types of mental illness

l By understanding these illnesses better, we hope to increase understanding, support and help seeking for those who are suffering

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What defines an “illness”?l All experiences exist on a continuum from

healthy to unhealthyl A few sad days à Sad all day, for weeksl A few drinks with friends à Drinking all day, alonel Be nervous before a test à Having panic attacks

and being afraid to leave your house

What defines an “illness”?l We say things are “unhealthy” or “abnormal”

when they are…l Pervasive – happen in many situationsl Persistent – happen all the time, don’t go awayl Are very, very upsetting to youl Have a big, negative impact on your life

l These factors highlight the need to seek help!

What causes Mental Illness?

Diathesis-Stress Modell Humans can inherit a host of biological

vulnerabilities for mental illness – not the disorders themselves

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Autosomal Dominant (A)Inheritance

AaAffected

(25%)

AaAffected

(25%)aa

Unaffected (25%)

aaUnaffected

(25%)

Affected Father

Aa

aa

Unaffected Mother

A

a

a a

Genetics

What causes Mental Illness?

Diathesis-Stress Modell Humans can inherit a host of biological

vulnerabilities for mental illness – not the disorders themselves

l Stressful life events and circumstances activate these vulnerabilities

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Diathesis-Stress Model

Threshold

Stre

ss

High

Low

Presence of Symptoms

Absence of Symptoms

Genetic/Biological VulnerabilityLow High

What is “stress”?l Traditional view of stress:

l Any challenging event that requires physiological, cognitive, or behavioral adaptation

l Creates psychological strain for an individuall Is a normal part of life – from daily hassles (e.g.,

getting to class on time) to major events (e.g., breaking up with a partner, death of a loved one)

However, the same stressor can hold somewhat different meanings for different people…

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Typical Stressors for Youthl Changes in life circumstances:

l Divorce, death of loved one, moving to a new placel Social stress

l Peer conflict, bullying exclusionl Traumatic events

l Abuse/neglect, experience natural disaster, accident, fire

l Medical or physical conditionsl Use of substances that alter the body’s

functioning

Impact of Brain Development

What causes “stress”?l Stress = individual’s subjective reaction to a

challenging life event (Lazarus’ Model)l Example: An Upcoming Test

l Primary appraisal = What is the challenge, threat, or harm posed by this event?l How many chapters does it cover? What percent of my grade

is it worth?l Secondary appraisal = What abilities or resources do I have

to cope with this event?l How much time do I have to study? What are my study skills?

l Stress = event + reaction

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Fight or Flight

l When we perceive something as “stress,” our bodies respond to take action against dangerl A dog surprised by a growling bear can either flee

to safety, or bark and bite at the bearl An army soldier startled by fire can either run to

safety, or shoot at the opposition

l Response to clear and imminent threats to safety to help us survive

Stress àfight-or-flight response àsympathetic nervous system (SNS)

Heightens attentionProvides energyPrepares body for injury

Decrease immune function to prepare body for action

Effects of “Stress” l In short-term, with imminent threat present, body’s

response can be very adaptivel BUT chronic stress leads to an ongoing biological

response with negative consequences….l Reduced bone density, muscle tissue l Increased blood pressure and risk for heart attackl Immunosuppression leads to increased illnessl Use of substances directly impacts bodyl Reduced cognitive performance impacts coping – can

lead to mental health issues

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Diathesis-Stress Model

Threshold

Stre

ss

High

Low

Presence of Symptoms

Absence of Symptoms

Genetic/Biological VulnerabilityLow High

What causes Mental Illness?

Diathesis-Stress Modell Humans can inherit a host of biological

vulnerabilities for mental illness – not the disorders themselves

l Stressful life events and circumstances activate these vulnerabilities

l Poor coping skills, lack of support and/or continued life challenges contribute to the development of mental health issues.

Difficulty Coping with Stressl When stress is overwhelming, our ability to cope can

breakdownl We may turn to other methods of coping, some of

which may NOT be effectivel Alcoholl Drugsl Suicide, self harml Running awayl Fightingl Giving up à poor self care, school functioning, social

withdrawall Mental health difficulties typically develop

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Let’s think about the early signs of some common illnesses…

l Each of these illnesses has their onset in late childhood or adolescence…

l Anxiety

l Depression

l Psychosis

Early Signs of an Anxiety Disorderl 25% of adolescents and 28% of adults will

experience an anxiety disorder in their lifetimel Excessive worry à may lead to sleep or physical

problemsl Fears that are out of proportion to the situation

à avoidancel Panic attacksl Perfectionism or fear of mistakesl Fears related to people – abandonment

(children) vs embarrassment

What is trauma?

A traumatic event is defined as exposure to actual or threatened death, serious injury, or sexual violence.

Complex developmental trauma involves traumatic stressors that 1.Are repetitive and/or prolonged2.Involve direct harm and/or neglect by responsible adults3.Occur at developmentally vulnerable times in the victim’s life4.Have great potential to severely compromise a child’s development

American Psychiatric Association, 2013; Cicchetti, 2004

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PTSD in children

Symptom Clusters:l Re-experiencingl Avoidance/numbing l Hyperarousall Altered Cognitions

Other Criteria:l > 1 monthl Clinically Significant

Impairment

Symptoms common in children:l Changes in playl New fearsl Separation anxietyl Distress at reminders l Sleep disturbancesl Somatic complaintsl Developmental regressionl Acting out, irritability, aggressionl Withdrawal l Sadness, depressionl Difficulty with attention,

concentration, & memoryl Exaggerated startle response

APA, 2000; 2013 Carrion et al., 2002; Street & Sibert, 1998

Depressionl Everyone experiences a

wide ranges of moods –from sadness to happiness to anger –often in response to environmental situations

l However, 11% of children and 17% of adults will experience depression

Early Signs of Depressionl Prolonged periods of sadness, hopelessness,

or worthlessnessl Persistent poor self-esteem

l Loss of interest in fun or enjoyable activitiesl Changes in sleep, appetite, thinking, and

energyl Can affect many areas of life – relationships,

school/work, activitiesl Can lead to suicide or self harm behaviors

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Early Signs of Psychosisl 20% have these experiences at some point, but 3%

will have persistent difficulties that affect their livesl Suspiciousness – worrying that others might hurt youl Unusual thoughts or fears – mind reading, getting

messages from the TVl Grandiosity – having special gifts, being “chosen” for a

special rolel Changes in sensory experience – hearing sounds or name

being called, seeing shadows or ghosts

l Often occur in the context of other vague difficultiesl Decreased interest in school and social activitiesl Feeling overwhelmed by everyday things

What can help?l When faced with mental illness (like physical

illness), its important to seek help!l Sources of help

l Physicianl Mental Health Practitionerl Family, friendsl Schooll Community organizations – NAMI, Church

Coping with Stress & Mental Health Challenges

Can we change how we handle stress?

l Problem-focused coping = attempts to change a stressor or situation (e.g., looking for new job or major)

l Emotion-focused coping = attempts to change distress (e.g., deep breathing during a quiz)l “We must change our reactions, because we cannot

change our lives”l Meaning-focused coping = attempts to change the

“meaning” of the stressor or situation

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Thoughts

Feelings Behavior

Role of Our Thoughts…

Problem-focused Copingl DO SOMETHING to change the situation:

l Active Problem Solving: Identify the problem, generate potential solutions, try them out, evaluate outcome

l Increase predictability and control of stressl Keep a schedulel Create a plan of attack

l Seek social supportl Family, friends, teachers, community

l Distract yourselfl Seek Professional support – therapist, counselor,

doctor

Emotion-focused Copingl Change the way you THINK and FEEL about

the probleml Relax and think clearly

l Physical Activity l Deep breathing or meditation

l Identify what can be changedl Examine your feelings – anger, fear, sadness,

excitement…l Be Optimistic – The power of positive thinking

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Emotion-focused Copingl After you’ve acknowledged the problem, you

need to do somethingl Just “dwelling in the emotions” does not lead to

good changes OR decreased stressl Avoidance or poor coping can lead to other

problemsl Alcohol or drugsl Depression & Angerl Suicide

Meaning-focused Copingl Identify the “reason” or meaning for the adversity we

facel How are stressors interpreted according to our

values?l Example: With hard work comes great rewards

l How are stressors seen as expected in the path toward a goal?l Example: Tough practices in the heat are part of becoming

a winning football teaml Role of spirituality

Copingl All of one coping type – not good!

l Need to use different types of coping flexibly to successfully handle stress in a given situation

l BUT good problem-focused coping is an important skill to develop!

l Good physical health also helps us to cope with stressl Physical Activityl Nutrition

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How to support studentsl Keep your eyes and ears open – notice when

students are in distressl Respond with care and concern. Listen.l Support them to ask for help

l Help them if you can OR help them connect to the right supports

l Offer to talk to other support persons, family.l Send referral to school counselor for follow up

l Check in on them later to make sure they got supportl Problem solve around barriers if they didn’t

How to support studentsl Never promise to “keep a secret” - but upfront

about that.l If the issue is URGENT, respond

immediately:l Danger to selfl Danger to othersl Someone is hurting them or other children

l Contact administration directly

ANY QUESTIONS??